Much appreciated advice, Doctor James. Thank you so very much for your input!

Hello joy2world,

While it's possible your viral load will rise (a relapse) it's far more likely you will still go on to SVR12.

www.ncbi.nlm.nih.gov/pmc/articles/PMC4834854/

For that reason it is not appropriate to retreat yet. A simple repeat PCR at weeks 4, 8, 12 post treatment will tell us what is happening. If it goes undetected and stays there you are cured. If it rebounds you're not.

It would be premature to jump back on treatment until we confirm a relapse with a high viral load.

Your watch, wait and see idea is spot on.

Although your doctor is a bit over-enthusiastic on the retreatment front I'd look at it like this:

1) You will probably SVR (so don't worry too much)
2) If you don't your doctor looks like they can access retreatment (so don't worry too much)

So it's most likely you'll be fine with nothing more than a couple of blood tests to do. If not, you'll get retreated and cured second time around. Either way you're cured.

We are set for an appointment tomorrow to discuss. I’m going to request that we repeat the labs again in 1-2 months and go from there.

I just can’t fathom jumping right back into another treatment so quickly and prematurely. But at the same time, I don’t want the virus to rebound! It’s a tough spot to be in.

She is a very young doctor and liver disease is not her specialty. I’m still holding onto hope thanks to you wonderful people. Worst case scenario, we redraw labs in a month or two and I’m back at square one. We can retreat and jump back on the horse again. It will be disappointing, but there are other more aggressive (and longer than 8 weeks long) treatments out there. Yay science!

Thank you again so much for lending a much needed ear!

Can only imagine how you're feeling right now, although I do remember how I felt when it looked like the virus wasn't clearing.

The above referenced study states:

"Furthermore, contrary to past interferon-based treatments, low levels of HCV RNA detected at the end of short-duration DAA therapy, and even after therapy, do not signify treatment failure."

If I were in your shoes, I think I'd consult with my Gastroenterologist and have labs done again in 4 -6 weeks and make a decision based on those results, and not the initial EOT results.

But that's just me. You need to consult your physician, and do what you think is most prudent.

Received a message from gastro dr this morning and she considers this a total treatment failure.

“Yes, I saw those results this morning and was going to get in touch with you. If the medication was taken as prescribed for the total of 8 weeks, then this is a treatment failure. We will need to retreat with a different medication for virus eradication. Let me see if the clinic can get you set up for an appointment to discuss”

So now I’m back to feeling defeated again.

What should I say to this? I want to wait and have viral load checked again in a month or two? I really don’t want to go through another treatment if it’s unnecessary.

Hi Joy2world, sorry to hear that, however as fitz and Hazel said, your results do not mean that your're not cured. Please read this blog post by Dr James, it states that

patients should not be too alarmed if their viral load remains detectable at week 4, or even at end of treatment, as there is still a high likelihood of being cured. When treated with DAAs, having low-level detectable HCV RNA at the end of treatment does not preclude cure.

He referenced this study as proof (conclusion is on its first page).

So while it's not the ideal scenario, you should not feel defeated after getting this test result. Only a test done 12 weeks after end of treatment will tell you for sure if you were cured or not, best of luck.

Joy, from way on the other side of this (cured) I can remember how frightening and nerve wracking this entire process was. Early in my treatment, I'd log on from the US, and if my fellow travelers from Australia, and New Zealand weren't around yet, I'd honestly feel completely lost until someone I knew who was going through the same thing showed up.

I remember seeing other's results who were undetectable at four, or six weeks into treatment and feeling frustrated that I didn't seem to be clearing the virus as fast. Someone, perhaps Dr James, explained that it could take a while for the dead bits of virus to clear from my system.. Sure enough (can't remember exactly when), my results came back clear. I remember feeling such a sense of relief... I could hardly believe it, and actually didn't trust the findings.

As it turned out though, the virus was really, truly gone along with the death sentence that came with it. After a while even with an initial load of 9 million, the lingering bits and pieces were gone, forever.

Miracles do happen here with astonishing regularity, and you're likely free, forever.

There'll come a time, and sooner than you imagine when you'll look back on Hep C like a bad dream that's run its course, and you won't ever feel it closing in on you again.

Thank you both so much. This really makes me feel so much better. I was such a confused and nervous wreck this morning and astounded that it was still detected somehow! Even at unquantifiable amounts. I should be counting my lucky stars that the viral load went from over 3 million to <12 in a matter of 8 weeks. Just really wanted to see that undetected. Glad to see I am not alone, and it doesn’t mean treatment was a failure.

Again, I am so thankful for the responses. It’s taken a huge weight off my shoulders today!

Hi Joy2world
I can imagine that is stressful to see. In fact, I know it is as I have seen it happen to lots of people- who did go on to be undetected at 12 weeks SVR, which is the only test that matters.

This test of yours now, like Fitz says, could well be - ismuch more likely to be showing remnants of dead virus in your blood. I did 24 weeks treatment and wasn't undetected until 18 weeks of it. I kept really wanting to see those words- but I did.
If I was in your shoes, for reassurance at about 6-8 weeks after your last tablet, I'd get a liver function test. That tells much the same story but quickly and cheaply.

Meanwhile, take heart- many before you have cleared after getting this unsettling result, which is really a reflection of the testing capability we have- too sensitive, seeing and counting tiny dead bits and not sensitive enough, to show if it is live or not.

Don't be discouraged Joy. You may still have bits of dead virus floating around. As I recall, it can take some time

I’m a little discouraged today. I finally was able to get my EOT labs drawn and am still showing DETECTED. Viral load is under <12 and unable to be measured but the qualitative still shows detected.

I ended treatment April 28th and had labs drawn May 5th, so was only a week after EOT.

I’m thrilled to see my viral load go from 3 million to <12... but man. I was so hoping for it to be completely undetected.

Any advice or help would be greatly appreciated, as I feel so defeated at the moment.

Hi Gordon,

Thanks for your kind words. The timing is good. Currently, I'm dealing with a patient complaint where the complaint is basically that the patient did not like me telling them there was nothing wrong (despite the fact history has proven that to be the case) and that their self-diagnosis from Google was incorrect. It's weird - on the one side we have life and death disease where help is appreciated. On the other we have hypochondriacs wasting their time by writing, and far more of my time by having to answer baseless complaints.

Failing the only government-funded treatment first time around must have been shattering. It's been a honour to be in a position to help you get the job done second time around.

Please enjoy this video:

Hi all and a special shout out to Dr James...

My test results made their way through the queue of covid 19 samples finally and I have been informed that I have cleared the virus from my system. My Hepatology nurse rang me to let me know this and its still not quite sunk in yet.
I really want to thank you all for putting up with me and some of my dark and pessimistic posts on the forum, and your efforts to keep me positive about the chances of destroying the virus and especially during the horrible effects that the meds delivered up to me as side effects.
In particular, I want to thank you Dr James for extending your generosity in making the treatment possible for someone who had no hope in hell of paying for the drugs and had resigned themselves to coping with the deterioration of body and schooling up on how to best cope with that.
You are a legend to me Dr James and have helped me to again believe that their are some good people in the world who make positive changes in peoples lives.
Again thank you for helping me. I will now be able to more effectively and for a greater period into the future, help those who are suffering with the thoughts that lead to suicide and help them back from the brink or look after them after they entered the embrace of darkness but survived.
again this is us and what we do: www.taranakiretreat.org,nz. If you are in NZ and know someone that needs our non-clinical but enbracing support, or if you yourself cant climb out of a dark hole, reach out to us through the website above.
I will be lurking on the forum and website and hope to be able to have some input here if needed

my unfathomable gratitude and respect to you all

g

This is the correspondence I received from my test if it is any use to you at all:


Patient Details

Patient Name: PITCAIRN, GORDON A

NHI No: BAK7206

Date of Birth: 18-Aug-1971

HCV PCR RNA: <15 not detected

Copy To:CC Doctors: MADISON, BHAKTA.

Ordered by:CAMPBELL WHITE

Laboratory:

Observation date:08-May-2020

Not that that's a bad thing at all if it works.

Sadly it does not.

www.thelancet.com/journals/lancet/articl...(20)31022-9/fulltext

Interpretation
In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits.

Worse, the NIH did an emergency review and emergency press release because they knew this study was coming out.

Ignoring the Anthony Fauci backed, non-peer reviewed, non-published, interim analysis from NIH from 2 days ago www.niaid.nih.gov/news-events/nih-clinic...ry-advanced-covid-19 or not ignoring that and noting that report states:

Results also suggested a survival benefit, with a mortality rate of 8.0% for the group receiving remdesivir versus 11.6% for the placebo group (p=0.059) is far more accurately worded:

Results FAILED TO DEMONSTRATE ANY STATISTICALLY SIGNIFICANT survival benefit, with a mortality rate of 8.0% for the group receiving remdesivir versus 11.6% for the placebo group (p=0.059)
(despite being n=>1000...)

IF remdesivir delivers any benefit whatsoever it is, at best, in the ballpark of the benefit of ribavirin which, when added to Sofosbuvir and an NS5A is ~ 1% extra SVR12 ie so small you can barely measure it.

In short, remdesivir

• is not a potent NUC,
• it is not even close to a potent NUC and
• even at n > 1000 it has failed to demonstrate any significant benefit.

Compared to a real NUC like sofosbuvir it is complete and utter rubbish, leaving aside the issues that it is IV only and exists only at experimental scale.

Here is a reasonably thorough analysis of the remdesivir trials (credit Dr Andrew Hill)

There are 5 main randomised trials of remdesvir. We need all the results from these 5 clinical trials to be combined. Then we could interpret the overall outcomes in a meaningful way.

When the World Health Organisation review a drug, they always run a systematic review and meta-analysis of all available data.

A: Chinese trial of remdesivir versus placebo showed no benefits (Lancet publication), n=237

1. There is no effect of remdesivir on coronavirus viral load levels - they are the same as the control arm. With 237 patients, this trial show easily have enough statistical power to detect an effect on viral load.

2. Remdesivir was stopped early for adverse events in 12% of patients, versus four (5%) who stopped placebo early.

3. Mortality was 14% for remdesivir versus 13% for placebo.

www.thelancet.com/journals/lancet/articl...(20)31022-9/fulltext

B: Gilead's trial in severe infection seem to suggest that 5 days of treatment is better than 10 days. What does this tell us about how well the drug works? Why should less treatment show trends for better outcomes?

1. Clinical recovery: 65% for 5 days, 54% for 10 days of treatment

2. Mortality: 8% for 5 days, 11% for 10 days

3. Adverse events leading to discontinuation: 5% for 5 days, 10% for 10 days

www.gilead.com/news-and-press/press-room...with-severe-covid-19

C: NIH trial. Why was the clinical endpoint and sample size changed in the middle of the trial? n=1063, unpublished interim analysis.

This study, announced by Anthony Fauci, shows a slightly lower mortality for remdesivir (8.0%) versus placebo (11.6%), but this is not statistically significant. Remember that in the comparison of 5 versus 10 days of remdesivir, we also had 8% mortality for 5 days of remdesivir, versus 11% for 10 days of treatment. How do we interpret these two non-significant trends in the two trials?

Combined with the Chinese survival data, any difference in survival between remdesivir and placebo will be small and not statistically significant.

www.nih.gov/news-events/news-releases/ni...ry-advanced-covid-19

D: Missing data from the second Chinese trial.

This study of 308 patients was suspended for poor recruitment, but no results are available for the people who were actually recruited before April 15th. The website mentions 308 patients. What results are available? When will they be published?

clinicaltrials.gov/ct2/show/NCT04252664?...esivir&draw=2&rank=4

E: Main Gilead trial of remdesivir for people with moderate coronavirus infection (n=1600).

This trial is still ongoing, with results not yet available. We should see these results by the end of May.

clinicaltrials.gov/ct2/show/NCT04292730?...esivir&draw=2&rank=7

Even if remdesivir does show overall efficacy, there is the question of drug supplies. Will there be enough drug to treat everyone in need? Also the daily IV infusions of remdesivir will be a large burden on healthcare services.

Well, as far as the US Media is concerned, anything BUT Hydroxycloroquine. Gilead has now managed to get Remdesivir emergency approval, and it's being rolled out nationwide.

Not that that's a bad thing at all if it works. It's just disheartening to see effective non-proprietary treatments shoved to the back shelf of public consciousness in favor of what must be a relatively expensive proprietary treatment.

Hydroxychloroquine continues to be widely used, but continues to be panned by the mainstream press as "dangerous" and "snake oil", so people who were once rightfully hopeful have become wary.

It's really unbelievable that one of our political parties has so rabidly politicized the use of a proven and effective treatment that it is being smeared in favor of what looks like a less effective proprietary treatment. Make no mistake, this isn't the so called right we're talking about, and it is stunningly obvious, and equally shameful.

It's rather poetic that NYT is now touting Thorazine as a potential anti-covid panacea. Sort of a modern day NeoFascist "Soma" for the unruly freedom loving masses.